MEDICARE: DR. SAMUEL BUNDRANT DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7960	CO

General Provider Information

NPI Number	:	1023294436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL BUNDRANT DMD

Provider Business Mailing Address
First Line	:	9062 SUNSET RIDGE CT
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-2652
Country	:	US
Telephone Number	:	303-791-0893
Fax Number	:

Provider Business Practice Location Address
First Line	:	10900 SMITH RD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80239-3262
Country	:	US
Telephone Number	:	303-371-4804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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